What are the differentials to be sought?
The differentials include those for ring-enhancing lesions in the brain, the history of fevers put brain abscesses as a strong possibility. However, the findings can also represent a primary brain tumour as glioblastoma or a secondary metastases.
What is the next step on imaging management?
A Brain MRI should be performed to narrow and maybe give the most likely diagnosis.
Mltiple peripherally enhancing lesions with central hypodensity in the right frontal lobe. The largest lesions measures 2.9 x 2.2 x 1.7cm with multiple smaller lesions superiorly. Significant surrounding vasogenic oedema. There is effacement of the frontal horn of the right lateral ventricle, subfalcine herniation and right-to-left midline shift of 13mm at the level of the septum pellucidum. No tonsillar or uncal herniation. The left ventricle is not dilated
No other areas of abnormal contrast enhancement. Mastoid air cells and paranasal sinuses are clear.
Conclusion: Multiple peripherally enhancing lesions in the right frontal lobe resulting in significant mass effect. In the setting of fever, the findings are suspicious for cerebral abscesses. The differential includes metastatic lesions and a primary brain tumour. MRI is recommended to further evaluate.